RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00773
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for right knee pain, with a disability rating of 0%.

CI CONTENTION:  The CI’s condition continues to worsen.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

SERVICE PEB - 20041112	VARD - 20050614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5019	0%	Ileo-tibial Band Syndrome, Right Knee	5257	10%	20050511	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain condition began in 2001 after falling while participating in a ruck march.  Initial plain X-rays did not reveal any bony abnormality, but an MRI performed on 22 Aug 2002, noted an effusion (inflammatory fluid) in the right knee.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “iliotibial friction syndrome” for PEB adjudication.

At the MEB NARSUM examination performed on 18 & 22 October 2004 (2 months prior to separation), the CI reported right knee pain that improved with rest, and increased with prolonged standing and or sitting.  The MEB physical examination (PE) revealed tenderness about the right knee and range of motion (ROM) was minimally decreased at 0-130 degrees (normal = 0-140).  Clinical tests for ligamentous instability and meniscus pathology were negative.  At the VA Compensation and Pension (C&P) evaluation on 11 May 2005 (5 months after separation), the CI reported the inability to run due to increased right knee pain.  Painful flare-ups occur when squatting.  Her daily activities were not adversely affected.  Her PE revealed tenderness about the inner aspect of the right knee.  There was painful, but full ROM of the right knee.  Her gait remained normal.  There was no clinical evidence of joint instability.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5019 (Bursitis), citing knee pain with repetitive, strenuous, or prolonged use that prevented effective performance in her specialty.  The VA rated the right knee condition 10%, coded 5257 (knee, other impairment), citing recurrent subluxation or lateral instability of the knee which was slight.    

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the VA. The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition. 

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5257 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Iliotibial Band Syndrome, Right Knee	5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000088 (PD201500773)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA